School of Nursing and Midwifery, Australian Catholic University, 115 Victoria Parade, Fitzroy, Australia.
Midwifery. 2013 Feb;29(2):159-66. doi: 10.1016/j.midw.2011.11.006. Epub 2012 Feb 18.
women have consistently rated postnatal care less favourably than other episodes of maternity care. Midwives have also reported concerns with postnatal care, with challenges related to workloads, busy environments and lack of staff. Given these concerns, a regional hospital in Victoria, Australia redesigned its postnatal care provision. The changes included cessation of routine postnatal observations and the use of clinical pathways for women who gave birth vaginally; promotion of rest through minimal disturbances before 9 am; discouraging the use of the call bell system except in emergency situations; introduction of 'one-to-one' time with women; and promotion of normalcy and independence. This paper examines midwives' views of the changes and their impressions of the effects of the changes on women and their infants.
cross-sectional surveys of midwives were conducted six months after the changes to postnatal care were introduced then again, two years later. Midwives' views and experiences of the changes; the impact of the changes on confidence and autonomy of practice; views regarding the effect on women's satisfaction with care; and the perceived safety of the changes were explored.
a regional hospital in Victoria, Australia where approximately 2,000 births occur each year.
permanent part-time and full-time midwives.
response rates were 64% (50/78) at baseline and 60% (50/84) two years later. Overall, midwives were supportive of, and complied with, the changes to postnatal care. They agreed that change was needed and believed that the new way of providing care would be better for women and increase individualised care. Midwives also agreed that the changes would facilitate rest for women, believed that removal of routine observations for women after a vaginal birth was safe and that it would allow more time with women. Over time, midwives were more likely to feel autonomous when providing postnatal care. However, some concerns were raised, mostly in relation to the challenges around postnatal documentation, care provision without the guidance of a care/clinical pathway, and about limiting the use of the call bell to only emergency situations. Midwives were not confident that the changes would necessarily translate to a measurable increase in women's satisfaction with care, and were not confident that the changes translated into more time to spend listening and providing support to women.
overall, midwives were supportive of the changes and agreed that change to postnatal care was needed. Challenges remain around the most effective method of communication and documentation of postnatal care. It is important that when major changes to care provision are implemented that care providers' views and experiences are explored given their crucial role in the introduction and maintenance of changes and the potential impact on them as care providers.
女性一直对产后护理的评价不如其他分娩护理阶段。助产士也对产后护理表示担忧，主要与工作量、繁忙的环境和人员短缺有关。鉴于这些担忧，澳大利亚维多利亚州的一家地区医院重新设计了产后护理服务。这些变化包括停止对顺产产妇的常规产后观察，并为顺产产妇使用临床路径；上午 9 点前尽量减少干扰，促进产妇休息；除非紧急情况，否则不鼓励使用呼叫铃系统；为产妇提供一对一的时间；促进正常化和独立性。本文考察了助产士对这些变化的看法，以及他们对这些变化对妇女及其婴儿的影响的看法。
在实施产后护理改革六个月后和两年后，对助产士进行了横断面调查。调查了助产士对变化的看法和经验；变化对实践信心和自主性的影响；对提高妇女护理满意度效果的看法；以及对变化安全性的看法。
澳大利亚维多利亚州的一家地区医院，每年约有 2000 名婴儿出生。
固定兼职和全职助产士。
基线时的回复率为 64%（50/78），两年后为 60%（50/84）。总的来说，助产士对产后护理的变化持支持和遵守的态度。他们认为需要改变，并相信新的护理方式对妇女更好，并增加个性化护理。助产士还认为，这些变化将为妇女提供更多的休息时间，相信取消阴道分娩后对妇女的常规观察是安全的，这将使她们有更多的时间与妇女在一起。随着时间的推移，助产士在提供产后护理时更有可能感到自主。然而，也提出了一些担忧，主要与产后护理记录方面的挑战、没有护理/临床路径指导的护理提供以及限制呼叫铃仅在紧急情况下使用有关。助产士并不认为这些变化一定会导致妇女对护理满意度的显著提高，也不认为这些变化会转化为更多的时间来倾听和支持妇女。
总的来说，助产士对这些变化持支持态度，并认为产后护理需要改变。在最有效的沟通和产后护理记录方法方面仍然存在挑战。当对护理服务提供进行重大改变时，了解护理提供者的意见和经验非常重要，因为他们在引入和维持变革方面发挥着至关重要的作用，并且对他们作为护理提供者的潜在影响。
